North County trauma unit still in jeopardy

ESCONDIDO -- North County's only trauma center, Escondido's
Palomar Medical Center, is still in danger of being closed by Dec.
31 because of clashes over doctor pay, Palomar Pomerado Health
board members announced Monday.

"Palomar Pomerado Health is committed to providing stable,
reliable trauma services for the communities it serves," said
hospital board and finance committee member Ted Kleiter in a
prepared statement. "(But) if we are unable to reach an agreement
with our physicians within the time frame (Dec. 31) we will have no
other choice but to suspend trauma services. … I want to let the
rest of the board know this is not wrapped up and put away."

Unhappy orthopedic surgeons threatened to close the trauma unit
at Palomar in November by refusing to report for on-call duty.

But on Nov. 17, they signed last-minute "temporary" agreements
that would continue the elite, but expensive, emergency-room unit
until Dec. 31.

Because the temporary agreements paid the surgeons
"significantly" more than the $1,300 per-day stipend they already
earned, some doctors and administrators privately hinted they
thought the temporary pacts would form the basis of longer contract
extensions --- ending the trauma-center controversy.

But Kleiter said Monday night that administrators and the
orthopedic surgeons have still not agreed upon new contract
terms.

In addition, Kleiter said, the trauma unit's eight trauma
surgeons also are threatening not to renew their contracts, which
also end Dec. 31.

No doctors spoke at Monday's meeting.

But one orthopedic surgeon who spoke to the board in November,
Dr. Paul Milling, said doctors were not just unhappy with their
pay. Milling said doctors also wanted additional trauma room nurses
and assistants to improve patient care.

Palomar Medical Center is one of San Diego County's six trauma
centers -- emergency rooms that have the most modern equipment,
medical specialists such as neurosurgeons, orthopedic surgeons and
heart specialists on 24-hour call, and which treat the most
seriously injured and critically-ill emergency patients.

County trauma-system guidelines require that those specialists
be on-call, or the trauma unit cannot operate.

Palomar Pomerado Health officials expected its trauma center to
lose $1.7 million last year. However, hospital district officials
said recently that the system, which is supported by just $25,000 a
year from the county, finished "slightly in the black."

If Palomar were to close its trauma unit, its emergency room
would continue to function. However, trauma patients in North
County would have to be taken by helicopter or ambulance further
south for treatment. That, some say, could cost critically injured
patients precious minutes.

After Monday's meeting, Chief Executive Officer Norm Gruber had
little to say about the dispute, but noted that Palomar was forced
to suspend its trauma unit for "several months" about 10 years ago,
in another dispute of doctors' salaries.

"I just think we have to wait and see what happens," Gruber
said.

Contact staff writer Gig Conaughton at (760) 739-6696, or by
e-mail at gconaughton@nctimes.com